Prior Authorization

Also called: Pre-Authorization, Prior Auth

Common prompts: "what is prior authorization," "why do insurers require prior authorization," "prior authorization AI denials"

Definition

Prior authorization is a requirement by health insurers that a provider obtain approval before a specific medication, procedure, or service will be covered. Intended as a cost and appropriateness control, it has become a significant source of delay and friction in care — and a flashpoint as insurers deploy AI to process and deny requests at scale.

Why it matters

Prior authorization sits at the center of public anger over insurance practices, physician burnout, and the use of automated systems to deny care. It is a reputational liability for payors and a rallying point for providers and patient advocates. How an organization's prior-authorization practices are characterized — in coverage, regulatory debate, and the answer layer — carries real reputational and policy stakes.

Example

An insurer facing scrutiny over automated denials publishes clear, structured explanation of its prior-authorization process and oversight safeguards — shaping how AI engines and the public characterize its practices.